It seems so much simpler during presidential campaigns: Candidate X proposes Health Care Plan Y. A crowd cheers or falls asleep. The voters choose, and the country moves forward.

But then politics doesn't really work like that, and campaigns are fairy tales that never come true. The American system  three branches of government, checks and balances, partisan rancor  is built to fail and frustrate. Just two years ago, Obama's plan for health care was as well defined as his smile  15 pages long, with 65 footnotes, called "Barack Obama's Plan For A Healthy America." It promised affordable coverage for "every American," drug reimportation, increased use of generic drugs, and a savings of "up to $2,500" a year for the typical family. (See 10 players in health care reform.)

Such promises are now in large part inoperative. Reimportation was bartered away to get drug industry buy in  and an amendment to get it back in was defeated on the Senate floor on Tuesday  and a deal to delay the marketing of generic biologic drugs was added to the bill. The Senate plan would leave about 16 million Americans  and 8 million undocumented immigrants  uninsured. There are no firm estimates for the savings the typical American family should expect.

Yet still, Obama is campaigning, in a way. On Tuesday, he stood in the Roosevelt Room, calling again for the Senate to promptly pass something, because at this point, everyone seems to agree, something is what Obama and the Democrats need. "It's clear that we are on the precipice of an achievement that's eluded Congresses and Presidents for generations  an achievement that will touch the lives of nearly every American," the President announced. (Watch TIME's video "Uninsured Again.")

Obama had just met with most of the Democratic caucus in the Senate, hoping to push them to a final unanimous agreement. But given the divisions and tensions within the party, herding cats is cake by comparison. All around town, the pressure and the scramble has grown in intensity as the President and his team approach their ultimate goal of final passage of health reform early next year, after Senate passage and a merger of the bill with the House.

On all sides, Senators have been stepping up to complicate the picture further. Senator Joe Lieberman, an independent former Democrat from Connecticut, spent his day trying to explain why he would sink the bill because it included a provision to allow certain people between the ages of 55 and 64 to buy into Medicare, a provision that he voiced support for just three months earlier. Meanwhile, Senator Roland Burris of Illinois, the lame-duck appointee of scandal-plagued former governor Rod Blagojevich, threatened to walk away from the bill if Lieberman had his way, quoting Mohandas Gandhi on the Senate floor. "All compromise is based on give-and-take, but there can be no give-and-take on fundamentals," he announced. "Any compromise on mere fundamentals is a surrender." Senator Ben Nelson of Nebraska, one of the several moderate Dems whose support has constantly proved elusive on health reform, made clear that issues like the federal funding of abortion could still cause him to vote no. "I'm not on the bill," Nelson told Politico after the meeting at the White House. "I have spoken with the President and he knows they are not wrapped up today. I think everybody understands they are not wrapped up today and that impression will not be given."

Outside the chamber, chants of "Kill the bill" could be heard coming from a conservative "Code Red" rally across the street, which attracted a number of Republican Senators. Ironically, the former chairman of the Democratic Party, Howard Dean, issued a similar call in an interview with Vermont Public radio, saying that Lieberman's intransigence over the issue of a public option, or Medicare expansion, two ideas not contained in Obama's campaign proposal, should lead to a failure of the current legislation. "This is essentially the collapse of health care reform in the United States Senate," Dean said, according to The Plum Line blog. "Honestly the best thing to do right now is kill the Senate bill, go back to the House, start the reconciliation process, where you only need 51 votes and it would be a much simpler bill."

In the White House briefing room, press secretary Robert Gibbs tried to squash the Dean insurrection, by pointing out, somewhat ironically, that Dean had a different health care plan in his 2004 campaign. "What people like Howard Dean wanted, what members of the Senate and the House want now is a mix of increased accessibility for the millions of Americans that go every day without the safety net of health insurance," Gibbs said. "What others in the Senate and the House want are ways that we can control and contain costs for health care. Those are currently contained in the Senate bill."

In the days to come, more chaos can be expected. With no Republicans on board the plan in the Senate, any single senator who caucuses with the Democrats still has an opportunity to kill the health-reform bill. And the President has continued to focus more on passing something than on passing any single thing  an approach that critics have claimed only encourages Senators to follow Joe Lieberman's example by insisting on changes. "Now, let's be clear," Obama said, after the meeting with Democratic senators. "The final bill won't include everything that everybody wants. No bill can do that. But what I told my former colleagues today is that we simply cannot allow differences over individual elements of this plan to prevent us from meeting our responsibility to solve a long-standing and urgent problem for the American people."

It's not exactly the sort of message that drives people to the polls in an election year. But it just might be good enough to get some sort of health care reform passed in the next few weeks  and, Democrats hope, give the party a fighting chance at the polls next year.